Dr. Wendy Slusser 00:02
In the United States, almost 8 out of 10 members of the Gen Z generation and 7 out of 10 millennials reported being lonely in 2019. As if it could get any worse, many experts say even more people are lonely since the COVID-19 pandemic hit. Today, UCLA social well-being expert, Dr. Ted Robles, will discuss with me how stress, social support, and close intimate relationships can impact our health and well-being. Please join me in the first of a two-part episode, as we dive into Ted’s research. In this first part, we will explore how each of us can build stronger and moreresilient social networks and prevent loneliness. Ted, thanks so much for coming today. And we’re super excited to talk to you about your work, especially since it’s been real -actually, I’ve had a really steep learning curve related to your work, which I would like to say what your laboratory is called, which I think is kind of cool: Relationship and Health Laboratory. And your team focuses on a range of topics like relationships between social support and digital spaces and health, to how family functioning can actually worsen the effects of outdoor air pollution, which -it blows my mind even thinking about what that means. I think we’re going to delve on all those subjects. But before we get started on the details, I think it’s really important for everyone -because it was a real learning moment for me –is what is the definition of social well-being and also social connection?
Dr. Ted Robles 01:41
Oh, sure. Well, there is -depending on the discipline -there’s a lot of different definitions. The way I like to think of social well-being is: do you have a good number of relationships with other people that are high quality? So are these people that you can rely on for help if you need it? Are they people that can support you when you’re feeling down?And are they people who you can turn to for advice? And if you feel like you have that present, if you know that that resource is available to you, then I think you’re someone who has a pretty good degree of social well-being. Doesn’t have to mean that you have 500 friends, but what it really means is that you have people that you know you can turn to and that you can rely on.
Dr. Wendy Slusser 02:23
So it’s not about quantity, it’s about quality.
Dr. Ted Robles 02:26
It’s a little bit about quantity because it’s got to be more than zero, right? And there’s something to be said for not having, you know, one or two people that you rely on for all things. And there’s also something to be said for having a diversity of people who fill a lot of roles in your life, and that you fill a lot of different roles for a lot of people. But it doesn’t have to mean that you’re the most popular person who has, you know, every weeknight booked or anything like that, either.
Dr. Wendy Slusser 02:52
So I just heard you say it’s not just about what you can get from someone else, but what you can give to someone else. So it’s a two-way street.
Dr. Ted Robles 03:00
Yeah, absolutely. When we think about social support, and what it does for health, there’s some really interesting work suggesting that -reporting that you can give help to other people may actually be a little bit more beneficial than what you report getting yourself. Some of that obviously has to do with if I’m in the position to help, I’m obviously probably a little bit more functional. But at the same time, there may be benefits to providing care, not just you know, in a sort of parental sense, but giving back and that there may be benefits to doing that as well.
Dr. Wendy Slusser 03:34
And so, yes, speaking of like familial relationships, would you define social well-being to include family members?
Dr. Ted Robles 03:43
Absolutely. Yes, of course. Because those are relationships where you rely on people for support, you’re also giving support to people, especially as the kids get older to some degree. But even, you know, the young infants give us something, as well, in terms of feeling a sense of love and connection. And so, certainly, family relationships are a very important part of this overall construct of social well-being.
Dr. Wendy Slusser 04:08
So talking about children -thinking about what I started to do later in my practice, as pediatrician, was to be sure to ask children if they had a best friend. And what is that -does that sort of signify that that child has someone they can rely on if you define them as best friend? What does that mean in your discipline?
Dr. Ted Robles 04:33
Yeah, I think partly: 1) that you have a source of companionship -someone to spend time with, someone that maybe over time you develop an understanding with, you know, of each other or that someone understands you. You know, certainly, even you know, in kind of early childhood, or I’ll say sort of elementary school age, you know, it’s important to have someone who kind of sees the world in slightly the same way. Just so you feel like you’re not as, you know, alone or different, so to speak. And then that becomes ever more important, you know, as we grow older. And so having friends, certainly during -well throughout all of the life course -but the capacity to do that, and the capacity to be a good friend, are really important. You know, they’re evolutionarily important skills that we’ve had to develop over time.
Dr. Wendy Slusser 05:25
And that sort of -again, thinking about children and feeling accepted -that’s something else I’ve heard you and others in your discipline talk about is a sense of feeling included or inclusion. So can you address that a little bit?
Dr. Ted Robles 05:41
So oftentimes in our research we like to think of -I sort of traffic in a lot of romantic relationship kind of research, but I think the construct still applies across relationships -which is this idea of people being responsive to you. And I think that can also be subsumed under kind of the umbrella of inclusion. So responsiveness in our work is: do you feel that the people you’re with understand you? Do you feel like they value you -that they value your importance as a person as part of the group? And do you think that theycare about you? And if you’ve experience your social world as such -so if you experience your friends and your family as people who understand you, that they value you, and that they care for you -then we would say that you have sort of a high degree of, or you would describe the people around you as being very responsive. And so if we just broaden that a little bit more and think about an organization or workplace or an institution or a school, do I feel like the people here -maybe not everybody -but a good number of them understand my experience? Do they value my experience? Do they think that I’m a person who -it’s good that I am here in the place that I’m at? And do I feel cared for by the people who I work with, or by the people who instruct me, or through the staff that I work with? I think those things are also kind of a very important part of this overall inclusion experience. Because if you are at a place where you don’t feel understood by others, where you don’t feel like people care about you, where you don’t think that people think you have value, then that’s a recipe for feeling separate, and not feeling like, you know, then not feeling included, certainly. So there’s very, there’s sort of interesting similarities. There’s this -I come outof this close relationships work in psychology, but learning more about the sort of social belongingness work that you see in other areas of social psychology in particular, there’s an interesting merging there. And I think it all comes back to all of us as human beings want to feel like we’re part of something -whether that be the person I’m with right now, and also, you know, the larger group as well.
Dr. Wendy Slusser 07:56
I mean, you’re talking about feelings, which really leads me to consider what you’ve been doing, which is measuring people’s reaction, physical reaction. And feelings certainly are an emotional reaction, but also they stimulate a physical reaction. Can you explain to me what you’ve been doing with that because I find that fascinating.
Dr. Ted Robles 08:18
Yeah. So I like to think of how we -and I’m not alone in this. I’m very influenced by a lot of our colleagues here at UCLA in terms of ideas around how our biology was sort of evolved to interact with the social world. So I like to think of us as we walk around in our experiences, we’re constantly evaluating the environment for making sure that we feel safe, to make sure that life is as predictable as we can make it. And that includes the people around us. We like to have predictability in our social lives. You know I like to expect that someone who I can rely on today is someone who I can rely on tomorrow, or you know, a week from now, regardless of how I’m doing or how they’re doing with some boundaries, of course. And then having that certainty, having that safety is something that we monitor just like we monitor our energy state; or whether or not we have an infection; or whether or not our immune system is actively fighting something like an infection, or, you know, some sortof environmental pollutant. And so one of the functions of our brain is to really monitor the totality of our world, including our social world, and then direct our body to respond accordingly. And so, if we feel so short of any kind of physical exposure.So we’ll just sort of take, you know, infection and pollution, or other things out of the equation and just think about not feeling safe. If I don’t feel safe -if I feel very uncertain about my environment -that’s going to lead to these physiological changes to help me try to get back to a state where I feel more certain or where I feel more safe. You know, I might, you can think about the physiological changes that occur when you are nervous or when you’re uncertain. Some of that has a communicative value. So I’m trying to express to somebody: “I’m really unsure about what’s going on here. I need some reassurance,” for example. And maybe through that biological activity that’s happening in my brain and also in the periphery, outside my outside my brain, that then leads me to kind of get back to a state where I feel more safe and more certain. And that can also activate other aspects of our physiology that for them, it’s really important to know that I don’t feel safe or certain. So I studied the immune system, for example, and we know that the many aspects of our stress biology prepare our immune system to deal with impending threats. So some of my early work was on stress and wound healing. My graduate advisor studied stress and wound healing. Yep, like cuts. Exactly. And there’s really interesting animal literature showing that animals in sort of uncertain social environments, their immune system is primed to respond to infections much more quickly. And we think that’s because if they’re in an uncertain social environment, they just anticipate that they’re going to get hurt. And so their innate immune system needs to be more active and more prepared to respond when there’s an opening in the epidermis and bacteria starts to flood in -flood in through yourskin. And then there’s other work suggesting that, again, in uncertain social environments, that your immune system may be programmed to prepare to deal with infections, and maybe preference, dealing with certain types of infections like bacterial infections, but down-regulating other aspects of immunity, like antiviral immunity. And so just like, you know, our immune system responds to changes in our physical environment. So now we’ll bring back in things like infections and things like environmental pollutants, your immune system is also aware of what’s happening in our quote, unquote, social world as well, because it’s all part of the same world, right? And so that’s been really fascinating to kind of, learn, contribute to, and try to unpack over the course of what I’ve been doing over the last, you know, 12 years or so here.
Dr. Wendy Slusser 10:56
Wound healing. Like cuts? And do you think that’s brought some merit to your field in the sort of the medical world, so to speak, because often it’s reallynot even focused on -your social well being.
Dr. Ted Robles 12:31
Right? Yeah, I definitely think that’s part of it, for sure. So some of my work has been -we’ve been trying to demonstrate some of these ideas at the level of gene expression. And so when you can say that -so this is not my work, but this is a collaborator’s work, Steve Cole -when you can say that across several studies, people who report feeling socially isolated, that they have up-regulations of genes that are responsible for the inflammatory processes for promoting inflammation –
Dr. Wendy Slusser 13:04
Which is associated with Alzheimer’s and Parkinson’s and cardiovascular –
Dr. Ted Robles 13:09
Right. And cardiometabolic illness. And when I can say that, you know -being in a family environment where there are relatively higher levels of conflict, relatively lower levels of support, whether you’re a child or a parent, that both those things can activate some of the same molecular machinery, as well; that that does help, certainly, in gaining credibility with medicine. But I’ll also add that one of the things that’s been really important for my work and others, too, is demonstrating that this has clinically relevant impacts that you could observe. So that was why there was an initial interest in wound healing, not just on my part, but my graduate work at my graduate mentor. That’s why I was interested in assessing patient reported outcomes, like symptoms of the common cold or the flu, because those are the things you see as a physician, and that your patients come in and talk about and are concerned about; and I wanted to make sure that the link between the kinds of social things that I was interested in, linked back to the very complaints that patients would walk in the door with.
Dr. Wendy Slusser 14:21
But you know, I mean, there has been new research following -there’s that aging longitudinal study that talks about the risks of being healthy or being dead in the next five years. Right? And social isolation is one of the risks.
Dr. Ted Robles 14:38
Yep. Right, right.
Dr. Wendy Slusser 14:40
And it overcomes any other sort of medical diagnosis in terms of its risk -it’s among the highest.
Dr. Ted Robles 14:46
It might be sort of -it might contribute to many of those,at least the progression of many of those conditions, as well, whether it be through behavior -so being sedentary, not eating well, and also some of this physiology, too.
Dr. Wendy Slusser 15:01
Yeah, it’s really remarkable, emerging science -it sounds like -in terms of being able to link physiological changes with the emotional changes that are around being socially isolated or not. There are a couple of things I want to unpack here: 1) I mentioned emotional -and I’ll never forget being educated about the fact that, you know, emotional well-being and social well-being are distinct, but obviously interrelated. Can you expand on that a little bit?
Dr. Ted Robles 15:33
Well I always think of -so certainly social relationships, there is a significant emotional component. I mean, they’re one of the major sources of positive emotions, certainly. So when you think about things like feeling gratitude, and feeling compassion, and feeling joy, one of the main contributors to having sort of high levels of emotional well-being is certainly the social relationships that we have. And if you -people who study emotional well-being, they often find that one of the major contributors to emotional well-being is the social realm -having high quality social relationships. But of course, emotions are generated by lots of things; and certainly, not just the people that we’re with, but also the things that we experience as individuals, but also within sort of larger groups beyond just our, you know, the people that I interact with on a sort of one-to-one basis. So I mean, it’s kind of a simple example. You know, the experiences that you have, when you’re cheering for people, you know, for a team in an event, you know; that’s a really large communal experience, it’s not necessarily predicated on my relationship with the person sitting next to me on my left or right, but it is something that is bigger, and doesn’t necessarily involve these sort of one-to-one relationships. And also, having really unhappy relationships is oneof the major contributors to poor emotional well-being, as well. So you think about what puts you at risk for depression -interpersonal rejection is a major contributor to that, as well. But again, one of the really interesting things that we’re finding in psychoneuroimmunology is that not all depression is the same, and that’s actually -that’s not just a psychoneuroimmunology thing -that’s a psychiatry, psychology kind of finding. There’s many different ways to experience depression, some of which may involve how our immune system responds to our environment. And so there may be for some people, when you are exposed to even say something like the common cold or the flu, that that may -by generating these inflammatory processes -affect how we process information that then impacts how we feel. And so some of that may not necessarily be a function of the people that we’re with. I kind of am biased. I think that a lot of it has to do with how we process our social world, but at the same time, you know, things like experiencing anhedonia, or just things don’t feel rewarding anymore; that doesn’t necessarily just extend to people, it could extend to: “I don’t enjoy the movies that I used to enjoy”; “I don’t enjoy the food I used to enjoy.” And so that can be a way that emotional well-being is affected, but not necessarily through these sort of social processes.
Dr. Wendy Slusser 18:21
So of course, it’s quite complicated, right?
Dr. Ted Robles 18:23
Right, right. They’re highly intertwined.
Dr. Wendy Slusser 18:24
Yes, exactly. At the same time. You know, something that strikes me that I experience when I’m around someone that I really feel accepted by and that is giving to me and the expression, “it warms my heart”…explain to me what that -what’s happening in that situation?
Dr. Ted Robles 18:44
You know, there’s a really interesting literature on -I’m trying to remember. I just saw a kind of -something flew across my Twitter recently about a conference where they’re gonna be talking about the intersection between thermoregulation, so how we control our body temperature and how we experience temperature, and our social experience. So there are these really interesting studies where if you are holding a warm cup, that might actually affect how you perceive a person that you’re with. You might perceive them as being more socially warmer, for example. So this all goes back to some ideas around how some of our basic needs are processed by our brain; so things like hunger, things like warmth and temperature, things like pain that the circuitry that we then evolved over time, in our kind of really thick cortices, co-opted some of that same machinery. And so things like social pain of being rejected, so that feelings of being cold because you are left out, or warm because you had a really intense and meaningful experience with somebody, or hunger because you really miss somebody; that some of the neural mechanisms might have used some of the same machinery that we work in longer-term married couples showing that if they are more negative in these discussions, and these are couples who’ve been married for, you know, at least a decade or more, that their wounds heal more slowly, the more negative they are towards each other during these kinds of discussions.
Dr. Wendy Slusser 21:30
They’d volunteer for this? So, you know, getting back then to this concept of inclusion or not being included, that really translates to certain groups in our society that can feel this throughout their lifetime, right?
Dr. Ted Robles 24:07
Absolutely. Certain groups like African Americans, and I know African American women had this kind of data that’s related to their birth, you know, pregnancy and birth. Can you expand on that? Well certainly anybody who is experiencing marginalization of any form, right? And that can be because of ethnicity, as you alluded to, that can also be because of being a sexual minority, as well, and either experiencing both explicit forms of discrimination and prejudice, but also implicit forms that kind of live in the background –
Dr. Wendy Slusser 24:43
Implicit. Explain implicit.
Dr. Ted Robles 24:45
So I’m thinking about, on one hand, the ways that people think about other people, but aren’t consciously aware of, and then how they act accordingly. But in addition to that, I was also gonna say the sort of stuff structural pieces that form the kind of invisible but highly impactful framework in which we live. So if I live in a state where there are laws that discriminate against me, they may not be discriminating against me at this particular moment in time, but the accumulation of experiences that occur because of those laws, the norms that people have about how I get treated, that those can be highly impactful, and again, make someone feel like they’re not part of society, not part of this world. And we know that social rejection, kind of generally speaking, is definitely a risk factor that kind of amplifies our stress biology. We’re more vigilant for threats in the world, and our immune system, among other systems, responds accordingly by being prepared. And unfortunately by having an over-vigilant, prepared immune system, that has costs over the long-term for the very conditions you were describing before: cardio metabolic disorders, etc.
Dr. Wendy Slusser 26:03
Dr. Ted Robles 26:03
Right -pregnancy outcomes. Absolutely.
Dr. Wendy Slusser 26:05
I mean, this is definitely an emerging field in the degenerative diseases, as well, in particular, the aging brain. So what you’re describing is that social well-being and promoting social well-being and promoting inclusion and reducing prejudice is a really critical intervention for us to be able to enhance people’s well-being and physical well-being.
Dr. Ted Robles 26:33
Dr. Wendy Slusser 26:35
Part of the argument, initially, for why we wanted to focus not just on emotional well-being but social well-being as a distinct entity at UCLA, here, in the Semel Healthy Campus Initiative was this just incredible statistic or data point that came out about cigarettes. Can you explain to me this? This is scary.
Dr. Ted Robles 26:57
So one of the things we’re always interested in -the sort of psychosocial factors and health folks are interested in -is we want to make sure or we want to know, okay, if we benchmarked the risk related to being lonely, or to having very few friends against other known risk factors, like you know, how much of a problem is this if people are reporting high levels of loneliness? Because on one hand, you could imagine that the effect size is not big. I mean there’s a lot of things in this world, that in psychology, where the effect sizes are relatively small and –
Dr. Wendy Slusser 27:28
And what does that mean? The effect size?
Dr. Ted Robles 27:29
So I guess, the way I like to think of it is, if -let’s just pretend we’re talking about the likelihood that you’re going to get heart disease in 10 years. And if we imagine that there’s a cup, and that cup contains all the things that can put you at risk; and if different parts of that cup were different colored liquids, or different density of liquids. So let’s say I fill half that cup with exercise, so half of the reason that I’m at greater risk for developing heart disease is because of my exercise, or lack thereof, you know. Where does social isolation stack up? Is it about the same amount of -does it explain the same amount of variation and why somebody gets heart disease? Or is it less, and if it’s like a miniscule amount in that cup, then maybe it’s not that important for us to focus on. And so that’s why we wanted to kind of benchmark, and all of us who’ve done these kind of meta analyses, where we look at all the studies that have been done. And then we look at the size of, you know, what is the size of the relationship between marital quality, that is how you evaluate your relationship, and risk for death? Does that look about the same as something like exercise or something like smoking? And certainly for social isolation, you know, I didn’t do these analyses, but you know, my colleague, Julianne Holt Munstead did. And then when you look at how something like social isolation stacks up to not smoking, you know, the effect size is very similar, and in some cases, depending on your metric, it might be bigger. And so what that told us is that, you know, if you could mitigate social isolation, you might get some bang for your buck, you know, 10 years, 20 years down the road, and that it would be something that would be important to focus on. And so that was much of the motivation for trying to find, you know, how does this stack up next to something that we already devote a lot of money and time towards?
Dr. Wendy Slusser 29:25
And no, really. It can cause serious illness and death.
Dr. Ted Robles 29:30
Dr. Wendy Slusser 29:31
Social well-being is equivalent to smoking 15 cigarettes a day.
Dr. Ted Robles 29:35
Yeah, so I think they’re -they were looking at studies where, again, it was probably a meta-analysis of, you know, to what degree of smoking exposure over a certain amount of time was related to risk of early mortality. And so yeah, that ended up being the sort of equivalent effect, size-wise.
Dr. Wendy Slusser 29:52
So we just removed and actually have a tobacco ban on campus.
Dr. Ted Robles 30:00
Dr. Wendy Slusser 30:01
So, but meanwhile, we have to also be looking at how we can promote social well-being on campus because unbeknownst to us people are getting a dose of the negative impact.
Dr. Ted Robles 30:13
A couple -a pack and a half, right?
Dr. Wendy Slusser 30:16
I don’t know how many cigarettes are in a pack.
Dr. Ted Robles 30:18
But it is interesting that that is that statistic and other quarters that I have revolved in, I remember presenting some of my findings on marital quality and health at the Gerontological Society of America Meeting and a symposium. And that was really the thing was, wow, it was just amazing that this social factor was equivalent to like a smoking, for example. Yeah, yeah.
Dr. Wendy Slusser 30:40
And so I mean, what has evolved, clearly since you started as a grad student is, the World Health Organization lists social support networks as a determinant of health.
Dr. Ted Robles 30:41